Trauma is imprinted into the nervous system and shapes the developing brain from the moment of conception and potentially throughout life. Trauma has a long shadow.
Children are easily traumatised when fear is a dominant theme in their lives. If they spend much of their early life being scared and lack supportive adults to care and comfort them, they stay frightened. When a child is exposed to frightening experiences over prolonged periods of time this can result in what is known as developmental trauma. Trauma is toxic and interferes with how the brain develops.
The impact of early adversity on the developing brain:
The brain is rapidly developing in utero and during the first few years of life. A straightforward way of understanding this is to think of the brain growing just like a tree from roots to branches, that is, from brainstem to cortex. When the world is safe, predictable and nurturing, a child will blossom and grow. If their developing world is chaotic, threatening and devoid of kindness or caring relationships, a child is likely to suffer. The organisation and functional capabilities of the brain usually reflects a child’s early attachment experiences and holds the imprints of their suffering in the body.
Traumatic experiences early in life not only shatters a child’s inner sense of safety and security but can also profoundly alter the developing brain. Some examples may include:
- Exposure to alcohol, drugs and domestic violence during pregnancy
- Impairment of early bonding experiences during the critical perinatal period
- Chronic and pervasive experiences of neglect
- Multiple attachment disruptions, separation and loss
- Abusive and frightening caregiving experiences
- Relationally and cognitively impoverished home environments
The developing brain of an infant and young child is more vulnerable to the impact of trauma and neglect than that of adolescents and adults. Chronic trauma in the first few years can have profound effects on the developing brain even if a child is removed from an uncaring and neglectful environment.
Fear changes the way children think, feel and act:
Traumatised children live in a perpetual state of fear and sometimes terror. This is because their baseline state of arousal is altered by repetitive activation of their stress response system. Such heightened states of arousal deeply compromise a child’s ability to reach their full potential, to grow and learn from interactions with the world around them. This is because children who are frightened:
- Process and act on information differently than children who are calm and feel safe.
- Are rarely able to access a state of calm even when there is no threat.
- Use lower, more primitive parts of their brain and are much more vulnerable to being emotionally reactive.
- Find it extraordinarily difficult to deal with minor relational challenges at home and school.
- Struggle to manage strong emotions or find words to express their confused and scary feelings.
- Develop a rainbow of coping strategies, some of which may be seen in risk-taking behaviours or being emotionally shut-down.
- Can have enormous difficulties in receiving the care, nurturing and love they so desperately need.
A child may suffer from overwhelming feelings of sadness, loneliness and despair when those who are meant to care for them hurt and abuse them. Those feelings can only ever go away when someone helps them to heal.
Healing can only happen if:
- Therapeutic interventions/activities/experiences are sequentially matched to the developmental age, physiological needs as well as the unique strengths and vulnerabilities of each child
- We work to build a therapeutic web around children so that healing happens both within therapy and the therapeutic environment (home and school)
Dr Bruce Perry, an international expert on trauma, explains that children suffering from developmental trauma need key therapeutic experiences and activities that are neurobiologically restorative and reparative. This means they need to be:
- Relational – safe and trusting
- Relevant – developmentally age-appropriate
- Repetitive – patterned and sequenced
- Rhythmic – resonant with biology
- Respectful – of children, families and culture
It is also important that the assessment helps us select and sequence relationally relevant and rewarding therapeutic experiences that influence those areas of the brain that have been compromised by developmental trauma.
Specialist assessments for developmental trauma:
Careful consideration during the assessment process is given to key developmental experiences. This is because it helps us:
- Build a current picture of a child’s early developmental experiences as well as the caregiver’s own attachment history.
- Generate micro-elements of a child’s history, where possible, of the specific nature, pattern, timing and duration of trauma and neglect.
- Consider the potentially positive impacts of a child’s relational health history that act as a buffer, to early adversity.
- Assess and understand a child’s multiple “ages” (chronological, social, emotional, cognitive and moral).
- Assess the current attachment capabilities and relational sensitivities of a child or young person.
Building a considered and respectful understanding of a child’s unique vulnerabilities and strengths to ascertain their specific therapeutic needs also involves:
- Listening with kindness to a child or young person’s story as it unfolds in words or pictures.
- Listening with care to the parent/caregiver’s experience, observations and understanding.
- Observations of a child or young person at home and school.
- Talking to other professionals that may be currently involved with the child or young person, including school.
- Carrying out psychometric tests/questionnaires to help build a more comprehensive developmental picture of a child and their family.
- Reviewing previously completed paediatric, developmental, educational and/or psychological assessments.
Consultation following the assessment will set out some of the key recommendations for sequencing therapeutic interventions. This may not necessarily lead to direct therapeutic work in the first instance, but rather a sequence of planned therapeutic experiences and activities both at home and school. The recommendations may also highlight the need for further specialised assessments.
Therapeutic treatments for developmental trauma:
Our approach to working with developmental trauma, whatever the treatment modality, is based on a Neurosequential assessment and understanding of brain development. We incorporate the key principles of neurodevelopment into all our therapeutic work to ensure that it is relationally relevant and neurobiologically restorative.
Some of the recommended therapies for developmental trauma are:
Child and Adolescent Psychotherapy
Child and Adolescent Psychotherapy offers an effective treatment for emotional and psychological difficulties from infancy through to late adolescence. Child and Adolescent Psychotherapists are dedicated to understanding the complex emotional lives of infants, children, young people, families and carers in great depth. This approach seeks to look below the surface of problematic behaviours helping children, young people and their families/carers understand and make sense of what is driving such difficulties. One of the key aims is to understand what a child or young person is attempting to communicate through difficult emotions, behaviours and play. Their distinctive training enables them to develop and sustain relationships with children and young people whose difficulties may be rooted in early trauma, attachment disruptions and neglect, which often renders them vulnerable to blocking opportunities for the care and nurturing needed for healing and recovery.
Child and Adolescent Psychotherapy works with children and young people individually or with other family members as well the professional network around them to actively encourage a deeper understanding from the child’s perspective. During a therapeutic session, younger children may be encouraged to play, while older children may be asked to draw or paint and teenagers to talk about their feelings. Through the relationship with the therapist in a safe setting, the child or adolescent may begin to know and to feel able to express their most troubling thoughts and feelings. Gradually as these feelings are understood and put into words, there is less need in acting out through behaviour or unhelpful ways to self and other. Part of this process involves helping a child or young person build the internal resources that support their readiness for learning and their ability to form and sustain relationships with friends, family and other significant people in a child’s world.
What to expect from Child and Adolescent Psychotherapy:
- An exploration of a child or young person’s internal anxieties reflected through problematic behaviours and intense emotions
- Supporting a child or young person develop a better understanding of their troubling thoughts and hurt feelings so they can learn healthier ways of relating
- Supporting parents and carers better understand and make sense of their child’s communication attempts and to think with parents from the child’s perspective
- Supporting parents/carers to develop a more reflective stance as well as strengthen their resources for the task of parenting
Drama therapy is an extremely powerful and creative therapeutic intervention that focuses on the healing aspects of drama and theatre as an exploratory tool in therapy. The transformative power of theatre and storytelling captures the imagination in playful and magical ways. Drama and play are an integral part of children’s everyday lives as well as being a vital part of their emotional and social development. Drama allows a child or young person to explore difficult and hurt feelings in refreshingly novel and creative ways. Some of these include; play, role- play, story, art, music and movement. This may also involve a range of playful and fun activities using puppets, masks, paints and costumes.
The idea is to create an imaginative story that supports a child or young person create a safe space to communicate and explore difficult feelings without this engendering a sense of threat. The storytelling or fictional aspect of drama serves as an emotional filter and creative container. This helps children and young people work with hurt and confusing feelings in ways that offset the fear of being overwhelmed by allowing them to tentatively step towards an exploration at their own pace and more indirectly. Drama therapy works well with groups of children and young people, but also individually. It is an effective therapeutic intervention for a range of psychological and mental health difficulties with children and teens.
What to expect from Drama Therapy:
- Exploring feelings and relationships by using various playful ‘props’ such as puppets and other appropriate performance materials
- Support, encouragement and guidance in the creative engagement of dramatizing and transforming personal stories and painful feelings using artistic interventions
- Joint engagement in ‘make-believe’ as part of a shared experience to discover and self-create new perspectives on the survival of adversity and help build resilience
Dyactic Developmental Psychotherapy (DDP)
Dyadic Developmental Psychotherapy is a neurobiologically informed attachment-focused therapy originally developed by Dr Dan Hughes to work with fostered and adopted children who had suffered from early impaired bonding, trauma and chronic neglect in their family of origin. When a child is exposed to frightening experiences over prolonged periods of time this can result in what is known as developmental trauma. When the world is safe, predictable and nurturing, a child will blossom and grow. If their developing world is chaotic, threatening and devoid of kindness or caring relationships, a child may suffer from overwhelming feelings of sadness, loneliness and despair. The family-focused therapeutic interventions of DDP works towards repairing the trauma of early abuse and neglect.
DDP gently weaves the key neuro nurturing principles of sensitivity, attunement and responsiveness into all its therapeutic interventions. This provides a foundational therapeutic platform to restore trust and safety required to work with a child’s compromised attachment capabilities and relational sensitivities. This approach prioritises the vital role of adoptive parents, foster parents and other key attachment figures in helping a child heal from the trauma they have suffered in early life. Therapeutic parenting based on the key principles of PACE is also regarded as a vital part of the healing process. This involves the kind of parenting that seeks to nurture playfulness, acceptance and curiosity to deepen connection and foster attachment.
What to expect from DDP:
- Working with parents/carers to build on their natural parenting style in ways that enhance sensitivity and attunement to the complex attachment needs of their child
- Supporting parents/carers to reflect on how their early attachment histories shape their parenting style and attachment communications
- New ways of understanding the difficulties traumatized children face in attachment relationships and building key therapeutic resources to cultivate trust and safety
- Working with both parents and children to create opportunities for attunement and override patterns of ‘blocked care’ through playfulness, curiosity and empathy
Eye Movement Desensitization and Reprocessing (EMDR) is a distinct therapeutic intervention or technique that uses what is called bilateral stimulation (BLS) in order to help process distressing memories related to traumatic experiences. When children and young people experience traumatic and negative events like abuse, bullying, violence at home, accidents or the sudden death of someone close to them, the brain creates special memory boxes or files that hold all those painful and distressing thoughts, feelings and body sensations connected to these events. Children who have experienced traumatic events can easily get stuck in defensive behavioural patterns, often reflected in heightened anger (fight reactions) or chronic avoidant behaviours (flight reactions). This is the body’s solution to a perceived threat or danger only it no longer exists.
Unless a child or young person has support in processing distressing and traumatic experiences, they remain vulnerable to being triggered by small everyday reminders that may evoke similar feelings, such as being ignored, a friend or classmate making fun of them or by parents/carers asking them to do their homework or saying ‘no’. EMDR helps the brain reorganise these painful memories so they no longer hold the power to trigger feelings of anger, sadness and confusion, or leave a child thinking and believing that something is wrong with them or they are not good enough.
EMDR is not a ‘magical’ cure but is considered to be a safe and effective therapy for children suffering from post-traumatic stress or who have a history of attachment difficulties. It can also be used alongside other creative therapies such as art therapy and play therapy depending on a child’s needs and age.
What to expect from EMDR:
- One of the many things that happen with EMDR is we move our eyes from one side to the other while thinking about a negative and distressing event
- Listening to special music or tapping hands/knees or moving from one foot to the other to help the brain file away hurt and painful feelings, thoughts and body sensations
- Doing some drawings or art and perhaps puppet work as well as other rhythmic body-based activities to help the brain defrost and process bad experiences
Equine assisted psychotherapy (EAP) is a powerful and effective experiential therapeutic approach that uses the dynamic nature of horses to address a variety of emotional difficulties in children, young people and adults. It allows children and teens to take an active role in their recovery and provides a profoundly enriching environment for healing to unfold. The focus of equine therapy is not on riding or horsemanship but takes place purely on the ground through various structured interactions between children and horses. This often involves activities such as grooming, feeding, haltering and leading a horse that is supervised by a fully qualified Equine Psychotherapist and a Horse Specialist. Such activities naturally strengthen the capacity for assertiveness and development of problem-solving skills as well as relationship building.
During interactions with the horse, the equine therapists will observe certain patterns of behaviour or enquires on thoughts and feelings that may be emerging during a session. Our proximal closeness and/or distance during these interactions shows how the body is mapping the parameters of safety or threat, which is often a reflection of our early attachment experiences. Horses display gentleness and tenderness and their implicit sensory sensitivities together with their natural capacity for attunement and mirroring the patterns of behaviour in those with whom they are working offers tentative opportunities for forging a healing connection.
While Equine Assisted Therapy is used for a wide range of emotional and physical difficulties, for children and young people with traumatised attachment histories who struggle to feel safe in connection with another, the parallel nature of these interactions seems to be naturally attuned to the developmental and emotional needs of the child or adult. Children and teens who have suffered physical/emotional abuse often need to engage in ‘parallel’ relational interactions before they feel safe and secure to enough to be open to more relationally based therapies. The nurturing structure and form of parallel communication occurring during interactional activities allow for moments of emotional connection that can be felt and experienced in new and different ways.
Horses are large and powerful animals inspiring both awe and potentially fear. Taking tentative steps towards approaching a horse or making gestures to invite proximity are often foundational moments to override fear and cultivate the beginnings of relational safety. Moments of interaction where a small task/activity is accomplished provide a new template for dealing with challenging life experiences.
What to expect from Equine Therapy:
- Working on the ground with either one or two horses with two highly experienced practitioners: one a specialist in equine therapy and the other a horse specialist
- Working at a child’s own pace and supporting them make their choices about how they wish to approach and interact with horses
- Participate in simple exercises where appropriate like putting a bridle and saddle on the horse to actively encourage confidence and promote bonding experiences
Family therapy (also known as family and systemic psychotherapy) is an approach that works with families and those in close relationship to support each other in the service of fostering change. This may be parents and children together and also include grandparents or others who are considered important within the family system. Family therapy helps family members share difficult thoughts and feelings in a therapeutic space in the hope of cultivating a shared understanding and appreciation of the differing needs and experience of others within the family system. Family therapy can be particularly helpful in supporting families when they feel emotionally overwhelmed, full of sadness or frustrated and angry. It can also help when families feel stuck in knowing what to do for the best or stuck in patterns of hurtful and harmful behaviours.
Family therapy views relationships as deeply resourcing and seeks to help people who care for each other find ways of coping with emotional distress in more collaborative and supportive ways. It is a particularly helpful relational approach across a broad spectrum of difficulties including; adults struggling with parenting; for children whose parents are suffering from a mental health problem, school-related difficulties, self-harming behaviours, stressful and traumatic life events such as divorce and separation, premature death of a parent or partner. It is a particularly helpful approach in working with looked after and adopted children and the complex difficulties such families often face.
What to expect from Family Therapy:
- Support in understanding how the family is relating and communicating
- Help in feeling safe enough to talk about difficult thoughts, feelings and patterns of behaviour as well as support in talking about the challenges the family may be facing
- Developing specific strategies and skills to work positively with the conflict between adults and children
- Understand patterns of communication within the family and developing skills that strengthen communication and cultivate listening
Mentalisation Based Treatment
Mentalisation-based treatment (MBT) is an integrative form of psychotherapy that combines elements of psychodynamic and systemic therapy with CBT. It was originally developed by Professor Peter Fonagy and Anthony Bateman for people suffering from Borderline Personality Disorder (BPD). The term mentalisation essentially refers to the ability to think about thinking; in other words, understanding what is in one’s own mind and that of another in terms of emotional intention and intentional action.
Mentalisation-based treatment for children (MBT-C) and adolescents (MBT-A) is now widely recognised as being effective for a wide range of experience emotional and behavioural problems, including anxiety, depression, self-harming behaviours as well as relational difficulties. The ability to mentalise develops in early attachment relationships through emotional interactions with primary caregivers. If a child grows up in an attachment environment that is chaotic and neglectful their capacity to mentalise may become impaired or severely disrupted particularly if the caregiver is emotionally unstable or suffering from significant mental health difficulties.
MBT-C helps to promote a child’s ability to make sense of their own mind and the minds of others around them. It is also a developmental intervention and involves close collaboration with parents. The fundamental aim is to enhance the skills of mentalisation in both the parent and the child. Supporting children develop the capacity to mentalise not only promotes resilience but also nurtures a more positive sense of self, healthy relationships and better emotional regulation. This approach is also very effective with adolescents (MBT-A), particularly those with self-harming difficulties and other low-impulse control problems.
What to expect from MBT for children and adolescents:
- To support parents/carers develop the ability to mentalise so they can hold their child’s mind in mind
- A focus on the present and what is happening now in relationships with family, friends and peers to help a child and adolescent make sense of what is happening in their own mind and in the mind of another
- Working with troubling and distressing emotions in the here and now
- A focus on certain situations or interactions that trigger intense emotions (not behaviour) to enhance the capacity for mentalisation and self-regulation
- Develop the ability for understanding action and thoughts from others as well as their own impact on others in a more realistic manner
Music has been used as a therapeutic tool in the service of healing for centuries. Rhythm is regulating; all cultures have some form of patterned, repetitive rhythmic activity as part of their healing and mourning rituals, which is partly why music is often regarded as one of the most powerful forms of communication. The engaging nature of music itself along with the diversity of musical forms makes music uniquely effective in helping people of all ages, whose lives have been affected by trauma, mental illness, physical injury or disability through supporting their psychological, emotional, cognitive, physical, communicative and social needs.
As an expressive and creative art therapy, music seeks to utilise tempo, rhythm and musical improvisation to enhance the emotional, psychological and physical well-being of individuals. Musical interactions also help in the exploration of deeper feelings where sound replaces words and rhythmic melody becomes the primary vehicle for communication. Music therapy is not about learning music or learning to use a specific musical instrument. It is more simply about using and exploring the different melodies of sound through musical interactions with various instruments and facilitating a musical conversation with the therapist in the service of healing.
Music involves patterned, repetitive rhythmic activation of the brainstem and can be seen as a brainstem modulating therapeutic intervention. This is particularly helpful when working with children and young people who have suffered from early impaired bonding experiences, attachment disruptions and loss. Musical interactions encourage connection and bonding between mother and baby, which is especially helpful for women suffering from postnatal depression. Music therapy is also a widely recognised as a specialist therapeutic intervention for young people suffering from brain injury or other neurological disabilities to assist in rehabilitation and improve quality of life.
What to expect from Music Therapy:
- Working at a pace that is naturally attuned and responsive to your particular emotional and physical needs
- The capacity to explore musical forms of communication that gently encourage self-expression
- Taking part in rhythmic body-based activities to modulate and regulate states of anxiety, enhance relaxation and encouraging creative play
- Playing with musical interactions and alterations in tempo and rhythm as a gentle way of challenging habitual patterns of communication
Sensorimotor Psychotherapy is a body-oriented approach to working with trauma. This approach is fully grounded in contemporary neuroscience research and attachment theory, but also deeply informed by the philosophical and spiritual practices of Buddhism. It has evolved over the last three decades into a complex and elegant form of body psychotherapy that gently weaves kindness, compassion and embedded mindfulness into all its therapeutic interventions. As a ‘bottom-up’ approach, it helps us to think sequentially especially when working with early developmental trauma.
While many therapeutic interventions depend almost entirely on verbal narrative, Sensorimotor Psychotherapy utilises the wisdom of the body as a key therapeutic and self-regulatory resource. It offers a unique lens to explore the language of the body by focussing explicitly on the sensory landscape of body sensations and impulses, micro muscular patterns of tension, body movements, posture and gesture as well as facial expressions, gaze resting responses and respiratory rhythms. By prioritising the somatic narrative, it is possible to access the story the body holds by tracking and sequencing somatic states of arousal as well as working more directly with defensive patterns.
Sensorimotor Psychotherapy is a developmentally sensitive approach to working with children and young people who have histories of early impaired bonding and attachment disruptions or losses. Children who have suffered from early developmental trauma have compromised attachment capabilities and heightened relational sensitivities. This is reflected in defensive patterns of behaviour children with such histories exhibit as well as in their difficulties in tolerating and managing strong emotions. Children and young people are particularly vulnerable to being triggered by body-based physiological reminders of traumatic experience: sounds, smells, touch, body sensations and impulses as well as small shifts in posture, gesture and body movements. Sensorimotor Psychotherapy works directly with children’s disrupted capacity for regulation and disrupted attachment systems by helping them to develop physiological and somatic regulatory capacities. As a “bottom-up” approach, it recruits the wisdom of the body to support children and young people Regulate, Relate and Reason.
What to expect from Sensorimotor Psychotherapy:
- Helps children listen to the story of the body and helps them find words to describe this
- Helps a young person develop skills of sensing the internal world of body sensations, impulses, muscular patterns of tension, orienting patterns, movement urges and postural patterns
- Support children to direct attention to present-moment body-based experience; five-sense perceptions, sensory sensations, micro movement patterns etc, while being motivated by curiosity and playfulness
Sensory Attachment Therapy
For more information on our approach to assessing and working with developmental trauma see: The Neurosequential Model of Therapeutics